Passos Rogério da Hora, Caldas Juliana Ribeiro, Ramos João Gabriel Rosa, Batista Paulo Benigno Pena, Noritomi Danilo Teixeira, Akamine Nelson, Junior Marcelino de Souza Durão, Santos Bento Fortunato Cardoso Dos, Junior Virgilio Gonçalves Pereira, Monte Julio Cesar Martins, Batista Marcelo Costa, Dos Santos Oscar Fernando Pavão
Hospital São Rafael-Salvador Ba Departamento de Doentes Graves-Hospital Israelita Albert Einstein-São Paulo Hospital Português-Salvador-Bahia-Brazil.
Medicine (Baltimore). 2018 Sep;97(36):e12221. doi: 10.1097/MD.0000000000012221.
Metabolic acid-base disorders, especially metabolic acidosis, are common in critically ill patients who require renal replacement therapy. Continuous veno-venous hemodiafiltration (CVVHDF) achieves profound changes in acid-base status, but metabolic acidosis can remain unchanged or even deteriorate in some patients. The objective of this study is to understand the changes of acid-base variables in critically ill patients with septic associated acute kidney injury (SA-AKI) during CVVHDF and to determine how they relate to clinical outcome.Observational study of 200 subjects with SA-AKI treated with CVVHDF for at least 72 hours. Arterial blood gases and electrolytes and other relevant acid-base variables were analyzed using quantitative acid-base chemistry.Survivors and nonsurvivors had similar demographic characteristics and acid-base variables on day one of CVVHDF. However, during the next 48 hours, the resolution of acidosis was significantly different between the 2 groups, with an area under the ROC curve for standard base excess (SBE) and mortality of 0.62 (0.54-0.70), this was better than APACHE II score prediction power. Quantitative physicochemical analysis revealed that the majority of the change in SBE was due to changes in Cl and Na concentrations.Survivors of SA-AKI treated with CVVHDF recover hyperchloremic metabolic acidosis more rapidly than nonsurvivors. Further study is needed to determine if survival can be improved by measures to correct acidosis more rapidly.
代谢性酸碱紊乱，尤其是代谢性酸中毒，在需要肾脏替代治疗的危重症患者中很常见。连续性静脉-静脉血液透析滤过（CVVHDF）可使酸碱状态发生显著变化，但在某些患者中，代谢性酸中毒可能保持不变甚至恶化。本研究的目的是了解脓毒症相关性急性肾损伤（SA-AKI）危重症患者在CVVHDF期间酸碱变量的变化，并确定它们与临床结局的关系。对200例接受CVVHDF治疗至少72小时的SA-AKI患者进行观察性研究。使用定量酸碱化学方法分析动脉血气、电解质及其他相关酸碱变量。CVVHDF第一天，幸存者和非幸存者的人口统计学特征及酸碱变量相似。然而，在接下来的48小时内，两组酸中毒的缓解情况有显著差异，标准碱剩余（SBE）的ROC曲线下面积与死亡率为0.62（0.54-0.70），这优于急性生理与慢性健康状况评分系统（APACHE II）评分的预测能力。定量物理化学分析显示，SBE的大部分变化是由于Cl和Na浓度的变化。接受CVVHDF治疗的SA-AKI幸存者比非幸存者更快恢复高氯性代谢性酸中毒。需要进一步研究以确定更快纠正酸中毒的措施是否能提高生存率。
